Kalfas I H, Kormos D W, Murphy M A, McKenzie R L, Barnett G H, Bell G R, Steiner C P, Trimble M B, Weisenberger J P
Department of Neurosurgery, Cleveland Clinic Foundation, Ohio, USA.
J Neurosurg. 1995 Oct;83(4):641-7. doi: 10.3171/jns.1995.83.4.0641.
Interactive frameless stereotaxy has been successfully applied to intracranial surgery. It has contributed to the improved localization of deep-seated brain lesions and has demonstrated a potential for reducing both operative time and morbidity. However, it has not been as effectively applied to spinal surgery. The authors describe the application of frameless stereotactic techniques to spinal surgery, specifically pedicle screw fixation of the lumbosacral spine. Preoperative axial computerized tomography (CT) images of the appropriate spinal segments are obtained and loaded onto a high-speed graphics supercomputer workstation. Intraoperatively, these images can be linked to the appropriate spinal anatomy by a sonic localization digitizer device that is interfaced with the computer workstation. This permits the surgeon to place a pointing device (sonic wand) on any exposed spinal bone landmark in the operative field and obtain multiplanar reconstructed CT images projected in near-real time on the workstation screen. The images can be manipulated to assist the surgeon in determining the proper entry point for a pedicle screw as well as defining the appropriate trajectory in the axial and sagittal planes. It can also define the correct screw length and diameter for each pedicle to be instrumented. The authors applied this device to the insertion of 150 screws into the lumbosacral spines of 30 patients. One hundred forty-nine screws were assessed to be satisfactorily placed by postoperative CT and plain film radiography. In this report the authors discuss their use of this device in the clinical setting and review their preliminary results of frameless stereotaxy applied to spinal surgery. On the basis of their findings, the authors conclude that frameless stereotactic technology can be successfully applied to spinal surgery.
交互式无框架立体定向技术已成功应用于颅内手术。它有助于更精确地定位深部脑病变，并已显示出减少手术时间和发病率的潜力。然而，它尚未像在颅内手术中那样有效地应用于脊柱手术。作者描述了无框架立体定向技术在脊柱手术中的应用，特别是腰骶椎椎弓根螺钉固定术。获取适当脊柱节段的术前轴向计算机断层扫描（CT）图像，并将其加载到高速图形超级计算机工作站上。术中，这些图像可通过与计算机工作站连接的声波定位数字化仪设备与相应的脊柱解剖结构相连。这使得外科医生能够将指示设备（声波棒）放置在手术视野中任何暴露的脊柱骨标志上，并在工作站屏幕上近乎实时地获得多平面重建的CT图像。这些图像可以进行操作，以帮助外科医生确定椎弓根螺钉的正确进针点，并在轴向和矢状面中确定合适的轨迹。它还可以为每个要植入螺钉的椎弓根确定正确的螺钉长度和直径。作者将该设备应用于30例患者腰骶椎的150枚螺钉植入。术后CT和平片X线摄影评估显示，149枚螺钉位置满意。在本报告中，作者讨论了他们在临床环境中对该设备的使用，并回顾了无框架立体定向技术应用于脊柱手术的初步结果。基于他们的发现，作者得出结论，无框架立体定向技术可以成功应用于脊柱手术。
